Science Media Centre roundup

Expert reaction to editorial on serotonin and depression as published in The BMJ (British Medical Journal)*

“Prof David Healy’s article treads a path that is well-worn but out of date. He argues that selective serotonin re-uptake inhibitors (SSRI) antidepressants are used because of a pervasive myth that they boost serotonin levels, but this is something of a straw man. He makes the mistake of assuming that antidepressants reverse a functional abnormality in the brain that causes depression. Actually, the theory that low ‘levels’ of serotonin in the brain (whatever that means, functionally) causes depression died many years ago, in spite of the fact that a deficit in the synthesis of serotonin in the brain can trigger relapse of depression in some patients who are in remission: a fact which he also fails to mention.

“By contrast, the monoamine theory of ‘anti-depression’ is alive and kicking. There is plenty of evidence that SSRIs increase communication from neurones that release serotonin, as well as other monoamine transmitters, and that the ensuing downstream changes, such as creation of new neurons (neurogenesis) or modification of gene expression, can ameliorate depression.

“I am sure that most clinicians and scientists will be dismayed that a flawed argument is used to underpin a suggestion that the use of older tricyclic antidepressants, which are so dangerous in overdose, is always preferable to the SSRIs.”

The first thing about the Science Media Centre comment is it’s wild. It completely misreads the editorial it’s commenting on – at no point does the editorial say I or any academic ever believed the serotonin hypothesis or changed our beliefs because it has now been debunked.

In an extraordinarily brief space Clare Stanford introduces a whole new concept Switching on Anti-Depression – that no one I know has ever heard of. And also manages to say that there was never any evidence for the serotonin hypothesis but that the serotonin hypothesis is right anyway.

It’s hard to believe Clare Stanford wrote something like this.

Which raises the question – who are the Science Media Centre? There were several posts last June about the Science Media Centre and Sense about Science – see Follow the Rhetoric, First Admit no Harm, Follow the Lawsuit, Follow the Patient – cover aspects of what’s at stake. This is an organization that under the umbrella of taking a responsible approach to science ends up denigrating a lot of work or researchers that raise concerns about anything that might harm a corporation’s products.

Following the successful establishment of a UK SMC, comparable groups have been set up in Australia, New Zealand and Canada. See SMC Feasiblity Study for a document apparently stemming from a consultation exercise about what a Canadian SMC might look like.

Earlier this year a fuss blew up about coverage of HPV vaccines in the Toronto Star. The Star backtracked from its article, persuaded in part it would seem by input from SMC Canada that the Sixty cases of injured girls they had were just “anecdotes”.

The BMJ and other journals and media outlets divert a large amount of their content via the British SMC these days. They seem to think that this will increase coverage of their content – when the SMC is much more interested ordinarily to close down stories like this one rather than open them up. “We get our experts – who are usually media trained – to tell your journalists why you don’t want to bother with this story”.

Hmmm. I did have to read So Long twice to understand the thesis and appreciate the two questions.

On the page linked just above this comment, critics bring to mind the guests at the mad tea party.

Dr. Ma-Li Wong reports findings about the introduction of the SSRIs in relation to annual suicides in the USA between 1988 and 2002, hinting that SSRIs prevented suicides during that period, and that Healy’s writing was biased, inflammatory, and harmful.

I thought everyone knew that antidepressant prescriptions and suicides in the US rose together from about 1990 to at least 2013.

Like Dr. Stanford, Wong went off half-cocked, but at least managed to provide her own research to support some of her statements, including the false one.

Keedwell chides Healy for saying ADs cause dependence or provoke suicide, but doesn’t go on to deny the dependence problem. This is shocking coming from someone in his position; I would very much like him to take Paxil for 6 months and not a day more. He does deny the suicide risk, but provides no reference.

Taylor pulled a Stanford, leading off with an amply-punctuated and baseless complaint, presumably due to not having read the piece at all. Maybe someone just told him about it.

“Professor Healy makes a forceful but poorly supported argument against something which doesn’t and has never really existed: the idea that SSRIs ‘correct’ an ‘imbalance’ of serotonin in the brain.”

It is not clear how forceful a poorly supported argument that was not made against something that does not exist can be, but it was nice of Taylor to lead in with such warm praise for it.

Say, does Brintellix have a novel MOA in the brain, or does it work by provoking violent and protracted bouts of emesis? Such bouts do tend to improve one’s outlook, but it is still not known whether they correct a chemical imbalance in the gut or just relieve debilitating nausea.

Is So Long and Thanks for All the Serotonin not worth one reaction that is accurate, sensible, and documented? Or does it remind the pharmapolgists that they’re almost out of pill?

Hi David,
first of all the BMJ is not that bad, because they printed your serotonin article. And it is a nice article. With the fish in the headline it would have been even better.

I remember when I started my research in Depression … and went sceptical towards the leading opinion … than I was more than amazed, when I saw that you started clearing up the serotonin-fraud back to 1991http://www.ncbi.nlm.nih.gov/pubmed/1873625

It is a very good article – even after all these years.
But of course it is a pitty, that you have to write a similar article 25 years later.

We should have expected better data from the Serotonin-Supporters. Since new technologies have come up in the 25 years: FMRT, PET and even patch clamping is now easier than before. But what did we realize? The data of the Serotonin-Supporter is still not better than in 1991.

Maybe it’s very hard for scientists to realize that you need experiments to prove or disprove a theory.
Stanford hasn’t got a working experiment. I was looking for a science in her writing but … it wasn’t there.

I am trying to find any traces left of the report prepared under the Department of Business in 2010 “Science and the Media – Securing the Future”. This is from the Financial Times:

“Science and the Media – Securing the Future was commissioned by Lord Drayson, the UK science minister, and written by an expert group chaired by Fiona Fox, director of the Science Media Centre.

“The report draws on new research at Cardiff University about the health of science journalism in the UK, which is relatively reassuring.

“But the expert group warns about the serious threat to the quality and independence of science reporting posed by the wider crisis in journalism. As it points out, the economic and institutional constraints under which journalists now operate have in many cases caused heavier workloads, less time to seek out stories and check facts, more reliance on a very limited pool of news sources, and an growing homogeneity in science coverage.”

So, the Department of Business and Drayson, who donated £100,000 to New Labour and got a £32m contract to manufacture small-pox vaccine for his company Chiron, go straight to the industry funded SMC which presently lists the Department of Business, GSK, AbbVie, MSD, Novartis, Sanofi, Astra Zeneca, Procter and Gamble, ABPI etc, etc.

Also, if we consider George Monbiot’s famous article ‘Invasion of the Entryists’ one might ask where do this group of left wing intellectuals so concerned with the aims of industry – including Fiona Fox – come from? Was it the department of Business or its precursors (Department of Trade, Board of Trade ) all along?

The only people who ever argued that ssri works by increasing serotonin levels that are low in individuals with depression was the drugs companies trying to hype them up and sell them.
In the article DH wrote, I don’t see anywhere where he argues this point.
The only “well worn path” being trodden here is the path to Professor Healys door by people with their own agendas attempting to discredit him.
The ‘expert reaction’ to David Healys article makes me laugh. I’m no academic but even I could see that Clare Stanford hasn’t even read the article by DH or if she has then thats even more worrying given she is an expert. She has totally got the wrong end of the stick. Makes me ponder as to her reasons for writing this … A genuine academic scientific interest or a brief to discredit.

More arm twisting through advertising perhaps. The Clinton administration de-regulated pharmaceutical advertising by executive decree in the late 90s and pharma instantly became the dominating financial influence in the US media. Less need for Fiona?

NAMI, Mental Health America and the DBSA are not the whole story here, but they’re a big part of it. The sad truth is that almost all the “nonprofits” that are supposed to serve and represent people with various illnesses have been reduced to PR agencies for the drug and device industries. It’s true in diabetes, MS, arthritis — but nowhere more than Mental Health.

As for the “more academic” division of this army? I’d take a good look at the “medical and scientific advisory boards” of some of these nonprofits. It’ll warm your heart to see how many academic “Key Opinion Leaders” take time from their busy schedules to “give back” to charity in this manner. Here’s the DBSA, and the American Fdn. for Suicide Prevention:

Charles Nemeroff is a senior leader of the AFSP. Many “name” researchers, including Martin Keller of Paxil fame, are members of 2 or 3 of these councils. Gregory Simon, who may be the actual lead author of that miserable youth-suicide “study” published by BMJ last year, is a real up & comer in this field. The “non-scientific” board members come from three places: investment banking; public relations; and the private insurance and healthcare industry. What better place to shape your message?

It’s easy to see the Clare Stanford piece wasn’t written for fellow academics. It’s aimed at journalists, government types and activists like us. It makes no sense scientifically — but oh boy, it does sound awfully “Sciencey”! And none of the people with influence over her scientific career will mind in the least her putting her name to such babble. They know what it’s for.

We have also compared changes in monoamine transmission induced by the anti-obesity drug (and the monoamine-releasing agent), d‑amphetamine, and the reuptake inhibitor, sibutramine. We have characterised not only qualitative differences in the effects of these two drugs but also striking differences in latency of the monoamine responses to these compounds. It is these differences in latency that explain why d‑amphetamine is addictive but sibutramine is not. This work made a vital contribution to an application for a product licence submitted (to the FDA and, subsequently, worldwide) by our industrial sponsor. Until recently, sibutramine was the only centrally-acting drug licenced for treatment of obesity.

Oh goody a new drug coming up that will two birds with one stone. The world will be thin and happy.

I’m sure everyone will have looked at this already: but under ‘funding’ on the SMC UK website there is a handy pie chart. (link above). Biggest contributor? Industry and trade bodies. Add in the drug company funding of university research – well, I doubt if there is any truly independent source of financial support for them.

My guess is – it is part of the industry fightback. How on earth to counter them? But, awful though it is, the ‘article’ was so woefully inept it made me laugh. But that raises the question: what on earth is the BMJ doing, publishing it?

Depends which definition of ‘rogue’: a likeable chancer or – a dishonest and unprincipled person(s). Plus, of course, when applied to an elephant: a rogue elephant has savage and destructive tendencies. Personally I incline to a combination of the 2nd and 3rd.

The Daily Mail which is really rather wonderful on Health issues ran this piece today which is much better in colour with photos and claims for treatments of depression from yoghurts to Vaccines. They interviewed it seems lots of other people but not me.

Depression is NOT caused by low serotonin levels and most drugs used to treat it are based on a myth, psychiatrist claims
• David Healy is head of psychiatry at the Hergest psychiatry unit in Bangor
• Claims the idea low levels of serotonin causes depression is a fallacy
• Marketing of SSRI drugs like Prozac has been ‘based on a myth’, he claims
• Experts refute his claims saying ‘SSRIs work in the real world of the clinic’
By JENNY HOPE MEDICAL CORRESPONDENT FOR THE DAILY MAIL

The belief that the most popular antidepressant drugs raise serotonin levels in the brain is nothing more than a myth, a leading professor of psychiatry has claimed.
David Healy, head of psychiatry at the Hergest psychiatric unit in Bangor, North Wales, said the misconception that low levels of serotonin were responsible for depression had become established fact.

He suggested that the success of so-called SSRI drugs – which include Prozac and Seroxat – was based on the ‘marketing of a myth’.

The emergence of these serotonin reuptake inhibiting (SSRI) drugs in the late 1980s came after concerns about tranquilliser use to treat depression.

Even though they were weaker than old-style tricyclic antidepressants, they took off because of the idea that SSRIs restored serotonin levels to normal, ‘a notion that later transmuted into the idea that they remedied a chemical imbalance’.

In an editorial in the BMJ, Professor Healy said that in the 1990s, no one knew if SSRIs raised or lowered serotonin levels but there was no evidence that treatment corrected anything.

He said: ‘For doctors it provided an easy short hand for communication with patients.

‘For patients, the idea of correcting an abnormality has a moral force that can be expected to overcome the scruples some might have had about taking a tranquilliser, especially when packaged in the appealing form that distress is not a weakness.’

However, other psychiatrists have refuted the professor’s claims, saying the profession has moved on from a simplistic description of the pills correcting a chemical imbalance.

They warned the controversy might harm depressed patients if they were deterred from taking the drugs, which had been proved to work in trials and the ‘real world’.

COULD DEPRESSION BE AN INFECTIOUS DISEASE?
Depression should be re-defined as an infectious disease rather than an emotional disorder, argues one scientist.
The condition could result from a parasitic, bacterial or viral infection and future research into the condition should search for these micro-organisms, argues Dr. Turhan Canli, of Stony Brook University, U.S.
If his theory is true, he hopes a vaccination to protect against depression could be developed in future.
Writing in the journal Biology of Mood and Anxiety Disorders, Dr Canli said: ‘It is time for an entirely different approach.
‘Instead of conceptualising major depression as an emotional disorder, I suggest to re-conceptualise it as some form of an infectious disease.
‘I propose that future research should conduct a concerted search for parasites, bacteria, or viruses that may play a causal role in the etiology of major depression.’

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists, said: ‘That antidepressants are helpful in depression, together with psychological treatments, is established. How they do this is not.

‘Most researchers have long since moved on from the old serotonin model.
‘Most important of all, SSRIs are safer if taken in overdose than the older tricyclics.

‘People should not change their current medication on the basis of this editorial alone.’

NHS Choices, the website which advises patients, says: ‘It would be too simplistic to say that depression and related mental health conditions are caused by low serotonin levels, but a rise in serotonin levels can improve symptoms.’

Professor Healy’s editorial says it is important to raise questions about the drugs.
He said: ‘In other areas of life the products we use, from computers to microwaves, improve year on year, but this is not the case for medicines, where this year’s treatments may achieve blockbuster sales despite being less effective and less safe than yesterday’s models.

‘The emerging sciences of the brain offer enormous scope to deploy any amount of neurobabble.

‘We need to understand the language we use. Until then, so long, and thanks for all the serotonin’, he concludes.

Professor David Taylor, Director of Pharmacy and Pathology and Head of Pharmaceutical Sciences Clinical Academic Group, King’s Health Partners, South London and Maudsley NHS Foundation Trust, said: ‘Professor Healy makes a forceful but poorly supported argument against something which doesn’t and has never really existed: the idea that SSRIs ‘correct’ an ‘imbalance’ of serotonin in the brain.

‘Researchers and psychiatrists alike know that SSRIs are effective in a number of disorders but no one is sure exactly how they work. Their readily demonstrable effect is on serotonin but they have many indirect secondary effects in the brain.

‘Prof Healy fails to mention that SSRIs supplanted earlier tricyclics largely because of their relative safety in overdose, not because of any conspiracy concerning a theory of serotonin’s involvement in depression.’

Dr Paul Keedwell, Consultant Psychiatrist and Specialist in Mood Disorders, said: ‘In the real world of the clinic, SSRIs are undeniably effective in treating individuals with major depression.

‘They have become the first line treatment of choice because they have fewer troublesome side-effects than their predecessors, and are safer in overdose.
‘David Healy has previously claimed that SSRIs cause dependence or provoke suicide.

‘In so doing he has risked deterring individuals with severe depression from getting the help they need and this latest article just adds to this problem.
‘The risk of suicide from untreated depression is much greater than the risk of treating it with antidepressants, and yes, this includes SSRIs.’

[blimey, I can’t stay off this and will never get the damn book written…!]

Taylor and Keedwell are disingenuous. I don’t believe that the psychiatrists who prescribed antidepressants for me were involved in any ‘conspiracy’. I think they honestly thought that the SSRIs boosted serotonin and were more effective. It may not say much for their intelligence, and possibly indicates a degree of indolence in not keeping up with current research but I doubt they were conspiring with anyone. The ‘conspiracy’ lay in the cynical marketing and deliberate suppression of data.

As for Dr Keedwell’s assertion that the side effect profile of the SSRIs is far milder than the old tricyclics: has he ever taken either? Personally I found the vomiting induced by citalopram worse than constipation and dry mouth from clomipramine. Both types, new and old, induced akathisia in me. Which is possibly the worst side effect of all.

I have been reading all the comments on the article on the daily mail page. The majority are favourable. The ones that are not are because they’ve totally misunderstood and think DH wants their medications banning. I have of course left my own comments.
I think the article doesn’t read well to the general public who will just skim through it. Slap bang in the middle there’s something about yoghurt beating depression. So then you get people thinking that it’s about banning all antidepressants and banging a ski yoghurt down everyday instead. It’s also very naughty of them not to have asked DH to give his response to the others interviewed.
Even so the majority of the public’s comments are quite heartening I think.

In Norman Doidge’s book – The Brain That Changes Itself – page 241 there is mention of research about rats who took Prozac for 3 weeks had a 70% increase in the number of cells in their hippocampi.
I’m not being critical of the author because his books are very interesting and the book in question was published around 8years ago. However, people are still buying this book and they can still be influenced by misleading research.

I read Fiercepharma – an industry online trade mag. It’s a great source, because it reports on the companies and drugs purely as a commodity. It’s probably the most reliable source of info I have found. Sometimes the discrepancy between the PR of Eli Lilly, for example, and what Fiercepharma reports is so extreme that it’s laughable – were it not for the dishonesty involved. Eli Lilly’s Twitter feed drips silly tweets about the importance of treating dementia, suggesting that a cure is imminent, just as Fiercepharma reports that yet another drug for Alzheimers has ‘tanked’, along with every single other one in the dementia drug pipeline. Yesterday an ad came through from FP: for an e-book, which will help big pharma counter online security threats: It contained the following;

“Over the past few years a series of events have crystallized fears about data security into solid intel on real and significant threats against biopharma businesses. State-sponsored cyber-attack units, anti-pharma hacktivists and others have all upped the frequency and sophistication of their assaults on industry IT systems. And yet, with biopharma globalizing and disaggregating, companies cannot afford to shut off from the world. This is the dilemma faced by biopharma CIOs in 2015.”

It indicates how nervous biopharma is – I’d love to meet an anti-pharma hacktivist – I am completely convinced that there is a skilful and subtle counter attack going on. Vast commercial interests will employ any method in the book to protect profits.

One in 10 Americans are on an antidepressant, and many are taking SSRIs. But a new report underlines the fact that despite what Big Pharma says, we don’t actually know how they work

Though antidepressants are a common treatment for depression, psychiatrists still don’t have a clear understanding of how exactly they work. A new paper suggests that some explanations persist thanks to clever marketing, despite a lack of scientific evidence.

On Tuesday, David Healy, a professor of psychiatry at Bangor University in Wales and author of Let Them Eat Prozac, published an opinion piece in the journal The BMJ writing that the link between serotonin and depression is a “myth” that continues to be perpetrated by the pharmaceutical industry. Specifically, Healy says the marketing of selective serotonin re-uptake inhibitors—better known as SSRIs—has been problematic.

MORE: Do Depression Drugs Still Need Suicide Warnings?

“Drug companies marketed SSRIs for depression even though they were weaker than older tricyclic antidepressants, and sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety,” he writes. “The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance.”

While Healy has been described by some of his peers as an iconoclast, many members of the psychiatry community agree with him. “He’s preaching to the choir at this point,” says Dr. Victor I. Reus, a professor in the department of psychiatry at the University of California, San Francisco.

Reus adds that it’s not that SSRIs don’t work (though there are certainly some who do make that argument). Rather, it’s how they are marketed that is largely overblown. “My experience and belief is that they do work, but we don’t have a comprehensive and holistic understanding of why they work,” he says. “But I think [they] are in many cases remarkably successful even without understanding why they are so.”

The idea that SSRIs restore abnormal serotonin levels in the brain isn’t substantiated by research, so why does that line of thinking persist? According to Healy, the idea was adopted by physicians and patients as an easy way to communicate the confounding disorder and its treatment. That’s led to what he calls a costly distraction away from other depression drug research. Meanwhile, many other depression treatments have no effect on serotonin but can be effective against the condition, whereas some people who take SSRIs do not, in fact, get better.

“I think in essence the article raises a point that you have to think beyond SSRIs. They are not industry’s gift for the treatment of depression,” says Dr. Norman Sussman, a professor in the department of psychiatry at New York University Langone Medical Center. Some of the older drugs may actually work better with fewer qualit- of-life-impairing effects.”

Healy does not say that serotonin plays no role in the treatment of depression, writing that the compound is “not irrelevant,” but that the market boom of SSRIs raises questions about why physicians would put aside clinical trial evidence in place of “plausible but mythical” accounts of biology.

“My feeling is that these drugs maybe don’t work as well for depression as they do for other things like obsessiveness and anxiety,” says Sussman. “There are some people that do well on them but most of the evidence that’s come out recently is that they seem to work best in people that are the most depressed.”

Sussman says that SSRIs are often prescribed in primary care for people who have mild depression.

“You wonder what the real risk benefit ratio is in that population,” he says. “They’ve been oversold.”

“In short, SSRIs probably switch-on anti-depression, rather than switch-off depression…”
I read this sentence with disbelief, turning to anger that here we are,19 years after I had been suckered into the “low serotonin” and “chemical imbalance in the brain” in my doctor’s surgery, nothing has changed. “…probably switch-on anti-depression…” What????? The scientific and medical community still, with all their apparent brains and resources, cannot make a case for the efficacy of SSRI’s, but instead continue to stick to their guns and prescribe them to vast numbers of people for a variety of problems. Migraine, insomnia, PMT, back ache, frozen shoulder, broken relationship – just a few examples I have heard of amongst friends, family and the community in the past year. Even if I, as a layperson, could be persuaded that the low serotonin argument stands, how could it possibly be applied and be true in all those cases?
I can still remember the shock I felt coming out of the doctor’s surgery clutching a prescription for Seroxat, now holding the firm belief that there was something wrong with my brain, that I was on the edge of a clinical depression and that this drug could put it right. (In a pre-SSRI world he would have told me me that intermittent insomnia and worsening PMT was down to the peri-menopause.) And of course I also had the assurance of a Patient Information Leaflet that this new wonder drug was not addictive like the benzos. 17 years of addiction and 2 years of appalling withdrawal later, you can guess now that what really lowers my mood is seeing the lack of progress in this matter. This has been the pattern for the past 20 years – if you take SSRI’s and they work for you – big tick, good person. If you take them and you can’t handle the side effects– big cross, bad person. If you take them and can’t get off them – even worse, you are invisible. Now let’s pit all these people against one another, throw in some experts to stir the pot and stand back and watch nothing change. Despite the best intentions of some very committed people.
There is another myth that runs through this, one that implies that if you take any type of medication, the results you get are predictable. So where does my understanding of the uniqueness of my genetic makeup fit into this? What works for you may not work for me, and vice versa. How has that obvious truth become so divisive?
Opinions have become so polarized that there now seems to me a complete absence of compassion and humanity towards people who have and will continue to be damaged by the completely inappropriate prescribing of a whole class of drugs. Inaccurate science being used to frighten people into taking drugs which may harm them for conditions they don’t have. And that’s the nub of it for me. If I was able to look back and say “I was seriously ill and that diagnosis and drug made the world of difference to my life” maybe I could accept the difficulties of the past 19 years and the limitations of the movement disorder I have been left with. Ah, actually, it has made the world of difference to my life.
Was I oversold? You bet!

As one who was successfully sold the idea that my severe depression was caused by a chemical imbalance in my brain – I find the about-turn from the psychiatric community a really bitter pill to swallow. To say that none of them has ever really believed the ‘depleted serotonin’ theory either demonstrates a wilful dishonesty on the part of every doctor who has ever prescribed an SSRI, whilst telling the patient that their brain chemicals are disordered, – or an equally dishonest level of patronising contempt towards their patients. Ron Pies, in the US, came up with this explanation a year or so ago in an article in the Psychiatric Times. He kindly explained that his patients,( a middle aged woman was used as an example), would be reassured by the idea that their brain hormones were dysfunctional – and would take the medication. But, he went on to explain, he of course had never, ever, believed such a thing. It isn’t hard to find older articles by Dr Pies, enthusiastically endorsing the immutable scientific truth that serotonin is indubitably depleted in severe depression.

The low serotonin theory appears regularly in the press. A psychiatrist called Tim Cantopher expounded it last year in a large Guardian feature. It is arrant nonsense to say it has died a death – I wish it had.

lisa mentions the “well-worn path” to your door David by those out to discredit you, I am just so grateful that we have been able to tread a path to your door for your willing support on many an occasion – pity those on the other trail can’t see how many loyal supporters you have – or is that what is bothering them! Your willingness to help cannot be matched by ANY of them, that’s for sure. Keep fighting – we’re all behind you ( would be alongside you if we could)!

Here,here Mary. Well said.
David Healys supporters will stick by him like glue because for a lot of us his dedication and expertise has actually reached out and touched our lives. He does make a difference and there’s no agenda. With DH what you see is what you get. He is fighting to make medicine safer for us. Pure and simple.

Did you catch the part where proponents are up in arms about patients possibly getting full information about SSRI’s before deciding whether or not to use them? If patients make an informed choice it will be all Dr. Healy’s fault! Shame on you, Dr. Healy, for upholding your responsibility as a doctor!

Seriously, if docs find it useful to withhold information, the LEAST they could do is inform us of that and be the ones to sign the little piece of paper signifying that they chose not to give us the full story on medication THEY have decided goes in OUR bodies.

“Naughty Irishman – Last time I looked, he wasn’t outside any pharmacy pointing a gun at people who were walking out with their pills to alter the chemical imbalance that they haven’t got. Remember, we have to believe that the diagnosis of their ‘illness’ is based on a faith… it is widely believed, but we don’t know by whom.”

This paper “Linking Molecules to Mood: New Insight Into the Biology of Depression” best summarises the evidence of NO chemical imbalance. Written by lead NIMH “academic neuroscientist psychiatists” Vaishnav Krishnan and Eric J. Nestler
Full access here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031089/ and
the key paragraph is here: “Since monoamine enhancers improve depressive symptoms, it was suggested historically that depression is caused by deficits in monoaminergic transmission (“monoamine hypothesis”), which continues to be a prominent preoccupation of the field. However, after more than a decade of PET studies (positioned aptly to quantitatively measure receptor and transporter numbers and occupancy) (31), monoamine depletion studies (which transiently and experimentally reduce brain monoamine levels) (32) as well as genetic association analyses examining polymorphisms in monoaminergic genes (27, 33, 34), there is little (FOR WHICH READ “NO”) evidence to implicate true deficits in serotonergic, noradrenergic, or dopaminergic neurotransmission in the pathophysiology of depression.

The material preceding and following this is largely biobabble, and it might seem curious that with the massive lack of progress from SO much research it’s still being pushed – the key to why is in this final sentence: “We should look well beyond monoamines, cortisol, BDNF and the hippocampus to determine tomorrow’s novel medical and surgical therapeutic avenues for depression.” – i.e. thinking that “psychiatry’s” sole purpose is in finding “novel medical and surgical therapeutic avenues” – good medicine involves contextual, environmental, relationship, ALL modalities of easing suffering, but alas, not for the NIMH.

What ever happened to compassion? Couldn’t it become as billablle as that 5 minute med check, expecially if you cancelled out the pricy drug – took the drug out of the equation?
Why aren’t there doctors in the psychiatry world pushing for a different equation?

Yesterday, I went to a soft- spoken and understanding accupuncurist, learned both in his profession as well as in Chinese herbal medicine. After an hour of careful needling and gentle chat, he made me a cup of ginger tea. I felt like a million dollars and the hour’s cost was $50.

Maybe some self Compassion –
I practice Meditation (and Mindfulness and CBT). This approach works better than any psychotropic for ‘depression’ (and for the ‘bigger disorders’). This has been proved (see below):

Prompted by the question about the US version of SMC, investigation found the following data which are, I believe, worthy of some attention. Ten physicians say in a letter to Columbia University that Dr Mehmet Oz should go. The physicians cited his “disdain for science and for evidence based medicine,” his “baseless opposition to genetically modified foods [GMOs],” and his promotion of “quack treatments” for financial gain. “We are surprised and dismayed that Columbia University’s College of Physicians and Surgeons would permit Dr. Mehmet Oz to occupy a faculty appointment, let alone a senior administrative position (vice chair) in the Department of Surgery,” the physicians wrote.
Then, we find that four of the 10 signatories are past or present officials of the American Council on Science and Health (ACSH), a nonprofit group created in 1978, as it says, “to add reason and balance to debates about public health issues.” In op-ed pieces, studies, media interviews, and Congressional testimony, members of the ACSH have supported genetically modified foods, fracking, and e-cigarettes, all in the cause of battling “junk science.” Its web site (http://acsh.org/) lists more than 300 individuals — including more than 100 physicians — as members of its advisory board.
Critics of this group say that the ACSH is a front group for large corporations that fund it in exchange for ACSH’s defending products and practices that threaten public health.

Sorry to say it, but people like Clare Stanford really get on my wick. Have a bit of humility Clare. Nobody seems to ever mention the fact that depression will shift on its own in the majority of cases, and also people like Clare always fail to explain that even if there are changes in serotonin/dopamine perhaps this is merely the body’s way of creating the state of being, similar to the way, when one reacts in anger, the body raises cortisol and the body heats up, or when we feel love, tenderness and affection, we release dopamine, happy chemicals etc. These are ancient chemical processes in the body and brain. It’s just not as simple to say that depression lowers serotonin, therefore if we raise it- we can cure depression, because depression is triggered, for the most part, by external factors- life events, trauma, reactions to psychological stress etc.

I discussed this with a concerned journalist colleague, who recommended that I and other psychiatrists who have some expertise in this area nominate ourselves upon the Science Media Centres in our respective countries so as to provide a more measured, scientifically grounded, perspective upon stories such as these.

There is a Science Media Centre of the United States, website here http://www.sciencemediacenter.org/usa/ , which has links to the Science Media Centres of Australia, Canada, New Zealand, Japan and United Kingdom.

If you are a psychiatrist or pharmacologist reading this list post please consider nominating yourself as an expert to the Science Media Centre in your relevant country so as to provide a more grounded, measured, scientifically focused perspective upon stories such as these.

SSRI’s are starting to remind me of a kind of ‘active’ homeopathy. The practitioners swear it works but they have no idea how, the scientific basis behind the development of the medicine has long been debunked, along with the people that claim they know how it all works. The trial evidence suggests the compounds are really no better than placebo for most people, but clinical experience (anecdotes they want to hear) prove it works. The anecdotes they don’t want to hear – well they are just anecdotes. But of course it doesn’t work for everyone, and it really helps if you believe in the power of the medicine to heal, so whatever you do, don’t listen to the critics who say otherwise.

So now this ‘selective’ medicine that doesn’t really have any side effects of note, can be used to treat all sorts of problems. I’m not sure how they manage this – I guess they must take an SSRI and mix it with a little bit of say, cholesterol… dilute it, shake it, and dilute it some more and ta da! You have a new heart drug with minimal side effects. Magical stuff.

I don’t dispute that they ‘work’ for some, and I keep hearing experts claim SSRI’s are proven to ‘work’… but in what way exactly? What has to happen for them to be considered successful? How is that success measured?

If someone is on these medicines for 10, 20, 30 years and maybe claiming disability for long periods of time, are they working? If someone says they feel lots better, but at the same time their family life, professional life and physical health is deteriorating, are they working? If someone with an illness that often clears up in 6 months naturally, still isn’t better after 2 years of drugs, are they working? If someone says he is happy on the meds, but since starting them regularly visits prostitutes behind his wife’s back, are they working? If someone stops smoking but descends into crippling depression, are they working? If you’re a soldier being treated for PTSD and you end up living on the street, are they working?, If your PMS is relieved, but you end up getting divorce, does that mean your husband the main cause of your PMS all along?

I agree. I was prescribed Prozac in 1997. I was going through a divorce at the time and struggling to work and bring up 2 young sons on my home. The marital home was in negative equity and I couldn’t afford the mortgage payments on my own. So it was a difficult time I lost my home and my marriage broke down. I went to see my Doctor because I wasn’t sleeping very well and obviously felt very down. I came out with a prescription for Prozac.
After a month of taking it I thought yes it works I’m calmer and I felt like I had more energy. The reason I felt calmer was because I just didn’t care about my problems anymore. I can remember the day my decree absolute came and I felt absolutely nothing it could have been an electric bill. I used to go out once a week on a Saturday night and friends said I was a nightmare when I’d had a drink,argumentative, emotional and unstable and yet before Prozac I hadn’t been thought of like that. At the time I thought I was coping better because of Prozac but looking back I wasn’t and I made some impulsive and rash decisions that I honestly don’t think I would have done if hadn’t had all my feelings stripped from me. I can’t remember now why I stopped taking them, I only took them for about 6 months but when I did stop I didn’t act like that any more and started feeling things again.
I’m not saying it doesn’t work for some people but I don’t think it should be prescribed as a quick fix to a difficult time. I wasn’t clinically depressed, I was just sad at what life was throwing at me at that time. I didn’t need a drug to help me get through that and yet I was told that my serotonin levels were low and if I took the Prozac it would raise them and I’d feel better.
It does follow you as well that’s the only time I have ever been prescribed antidepressants and yet 18 years later at hospital appointments I’m still asked about my depression.

Good point. Here is a gem (which is not my own fabrication) that mentions efficacy AND effectiveness, but not what these efficacious agents affected.

“Our findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy and effectiveness. Differences with respect to onset of action and adverse events may be taken into consideration for the choice of a medication.”

“Roundup” is an interesting term. Is it to do with hunting down criminals or dissidents? Is it to do with poisoning weeds? Or just to do with affirming the authority of everything they say – the end of the debate (before it can even begin) as determined by them? You could join your local SMC but it might also be like joining the Communist Party in the former Soviet Union (how you get on?).

I moved surgeries in 2006 and started with a new blank page..a new folder.
The ‘history’ was in a bulky file gathering dust on the medical record shelves.

There was one question when I joined my new surgery.

Any previous medical history.

I thought about this at the time so wrote ‘side effects of Seroxat’.

Quite recently I was summoned to this surgery, where no one had discussed this with me, until…

A random locum wanted to talk about Seroxat…….heavens above……really?

He had heard of David Healy, read some of his books and was obviously itching to know what had happened to me. What happened he eventually asked.

I tried to kill myself I said.

He smiled at me. I told him my medication had not been checked after a week in our local loony bin. I asked him if he knew the people I was talking about.

He did. He said he was a locum in my previous surgery. He said he went there once and never again….

He also said about hospitals not checking on medication “I am not sure that is correct”.

The Clinical Director had told me it is not normal procedure to check on medication……

It was such a relief to talk face to face with a doctor about Seroxat after ten years of the ‘brick wall’ responses…as I had now held up his surgery for over an hour our conversation had to come to an end…..do you want me to write something down today, he asked, shall I put serious side effects from Seroxat…I looked at him, his pen poised, and, said, put “extremely serious side effects from Seroxat”.

We both burst into hysterical laughter.

I left cock a hoop leaving him scribbling away….I wonder what he wrote.

I once again wondered how I could ’round up’ those who had previously left me in such a perilous position.

Aannie – Great that your records are gathering dust somewhere and that a doctor actually listened to you.

When I moved from one Coast to another here in the states, I asked my old doctor to send the records. By the time I moved, I had come through a rocky withdrawal from psych. drugs I never needed in the first place – having originally been put on them (tricyclic and a benzo) at the end of a romance.

To make a long story short, my old doctor’s office never sent the records, thus giving me a clean bill of health! Simple as that.

It is usually up to your new surgery to request medical records from your old surgery, unless it differs in the US, state by state….

It also depends on how much you would prefer to move on with a clean bill of health or prefer to have some sort of vindication….

My medical records were well-travelled.
So, not only were they shelved but were dog-eared, ragged, pages out of context and so on…

I know this because the surgery and hospital I failed to sue by a top law firm in Glasgow said two inches of medical records had arrived in such a terrible state that they had to spend a few hours putting all the bits of paper in to some sort of order…

In 2006 I had not seen my medical records.

However, I requested the new surgery to have them copied and returned to my old surgery just across the loch. They did this for me without questioning as to why I wanted to do this. They also did it free of charge.

I wanted the new owner of the old surgery to check out my records.

I drove around the loch to see what was what.
He gave me an invoice for £99.00.

He also dropped a bomb. Vocally, not in writing.

That was all.

So, that was when I requested my medical records.

Pretty shock horror reading ones medical records.

In 2004 medical records were also photocopied for another law firm.

Not once, in the course of all this copying of two inches of bits of paper did one person ask me the reason for my medical records being copied.

Are all people robots….

Not to be one to let dogs lie, I have collected from 2006 various bits of paper including quite a vast number of pretty conclusive letters and emails from a witness, from the practice nurse, from the invoice man, from the clinical director and I could probably raise 50 or so friends, but, even, this is not enough…

If I had confidence in the GMC I could have a crack at it, but I have absolutely no confidence in that avenue.

[…] what it means. Healy wrote about her reaction on his blog, in an entry he pointedly titled “Switching on Antidepressants Today.” Healy doesn’t know what Stanford was talking about, his friends don’t, and my […]

Wouldn’t it be great to have this wonderful switch though that switches on anti depression. I wonder if they could improve it more so that it could switch on other things like an anti insomnia switch, anti stress, anti side effects, anti worrying that your son may end up in a prison cell because pharma lie about side effects switch. That would be marvellous.

In an editorial article, a UK-based Professor of Psychiatry says the widely held belief that depression is caused by low levels of the neurotransmitter serotonin in the brain – and that raising these levels with drugs known as SSRIs (e.g. Prozac) is an effective treatment – is a myth. This is a controversial view because SSRIs are the most widely used treatment for depression around the world.

For those journalists with a login, the report and any associated materials are available on Scimex.

Feel free to use these quotes in your stories. Any further comments will be posted on our website and on Scimex. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.
Professor Ma-Li Wong is Professor of Psychiatry, Flinders University, and Head of the Pharmacogenomics Research Program at the South Australian Health and Medical Research Institute (SAHMRI)

For the past decade, Prof Healy has held a stance against the pharmaceutical industry, specifically on fluoxetine (Prozac). His earlier book (The antidepressant era) was balanced and helpful; however, sadly, his later books disseminate inflammatory and biased views about fluoxetine. SSRIs [such as fluoxetine] may not be more efficacious than older tricyclic antidepressants; however, they have more a tolerable side effect profile.

This editorial is an opinion piece, which in my opinion is harmful to the field and patients as it disseminates biased opinions. Our own research concluded that:

A) The introduction of SSRIs coincided temporally with a substantial reduction in the number of suicides, which suggests that, in the context of untreated depression being the major cause of suicide, antidepressant treatment could have had a contributory role in reducing suicide rates in the period 1988-2002. (1)
B) Suicidality is a feature of the depressive state, and it improves along with other symptoms with antidepressant treatments. Our results did not support the hypothesis that SSRIs are associated with higher rates of suicidality than a tricyclic antidepressant.” (2)
C) In Mexican Americans with major depression, fluoxetine treatment showed a more rapid reduction of depressive symptoms and a lower incidence of side effects when compared with desipramine [a tricyclic antidepressant] (3).

Declared interests:
The research referenced in my comments was not sponsored by the pharmaceutical industry.

UK Expert Reaction:

Prof David Taylor is Director of Pharmacy and Pathology and Head of Pharmaceutical Sciences Clinical Academic Group, King’s Health Partners, South London and Maudsley NHS Foundation Trust

“Professor Healy makes a forceful but poorly supported argument against something which doesn’t and has never really existed: the idea that SSRIs ‘correct’ an ‘imbalance’ of serotonin in the brain.

“Researchers and psychiatrists alike know that SSRIs are effective in a number of disorders but no one is sure exactly how they work. Their readily demonstrable effect is on serotonin but they have many indirect secondary effects in the brain. Professor Healy also ignores very strong evidence that tryptophan depletion (which reduces serotonin production) reverses the beneficial effects of antidepressants with a variety of modes of action. He fails to mention that SSRIs supplanted earlier tricyclics largely because of their relative safety in overdose, not because of any conspiracy concerning a theory of serotonin’s involvement in depression.”

Dr Paul Keedwell is a Consultant Psychiatrist and Specialist in Mood Disorders

“Most psychiatrists are quite happy to admit to patients that they do not know precisely how antidepressants work. Their primary focus is on treating depression effectively and safely. They take into account evidence from trials but also recognise individual differences in response to different medications.

“In the real world of the clinic, SSRIs are undeniably effective in treating individuals with major depression. They have become the first line treatment of choice because they have fewer troublesome side-effects than their predecessors, and are safer in overdose. There is no evidence to suggest that they are less effective than the old tricyclics in general, although this could be true in individual cases.

“Exactly how SSRIs work could only be irrefutably proven by opening up someone’s brain. Even then, methods of observation would be likely to affect what we observe. Animal evidence and tests of blood, urine and spinal fluid of humans strongly suggests that serotonin function is affected in some way by these drugs. However, the profession is well aware of the fact that other systems are likely to be involved.

“Many individuals do not achieve complete remission with the first SSRI that is trialled, but this is also true of other types of antidepressant. We know from the large STAR-D trial that switching to a different type can bring about a successful outcome in many of these cases.

“There remain a significant number of people who are resistant to all existing forms of antidepressant, which is why more research is needed.

“The idea that a ‘serotonin myth’ is somehow restricting such research is simply not true. Ketamine, which is thought to work predominantly through glutamate receptors, had been shown in independent trials to bring about a rapid remission in at least a third of previously treatment-resistant individuals. Other drugs in development work on the interplay between noradrenaline and serotonin, or on novel manipulations of dopamine, melatonin, glutamate and the stress hormone cortisol. Psychiatrists have long known that therapeutic success likely involves a complex interplay between all of these brain chemicals.

“Hence, Healy’s assertion that disturbed serotonin function is not sufficient to completely explain depression is not news. However, his assertion that SSRIs may be less effective than older drugs is not supported by the evidence from clinical trials or the real world of the clinic.

“David Healy has previously claimed that SSRIs cause dependence or provoke suicide. In so doing he has risked deterred individuals with severe depression from getting the help they need and this latest article just adds to this problem. The risk of suicide from untreated depression is much greater than the risk of treating it with antidepressants, and yes, this includes SSRIs.

Dr Clare Stanford is Reader in Experimental Psychopharmacology, University College London

“Prof David Healy’s article treads a path that is well-worn but out of date. He argues that selective serotonin re-uptake inhibitors (SSRI) antidepressants are used because of a pervasive myth that they boost serotonin levels, but this is something of a straw man. He makes the mistake of assuming that antidepressants reverse a functional abnormality in the brain that causes depression. Actually, the theory that low ‘levels’ of serotonin in the brain (whatever that means, functionally) causes depression died many years ago, in spite of the fact that a deficit in the synthesis of serotonin in the brain can trigger relapse of depression in some patients who are in remission: a fact which he also fails to mention.

“By contrast, the monoamine theory of ‘anti-depression’ is alive and kicking. There is plenty of evidence that SSRIs increase communication from neurones that release serotonin, as well as other monoamine transmitters, and that the ensuing downstream changes, such as creation of new neurons (neurogenesis) or modification of gene expression, can ameliorate depression.

‘In so doing he has risked deterred individuals with severe depression from getting the help they need and this latest article just adds to this problem. The risk of suicide from untreated depression is much greater than the risk of treating it with antidepressants, and yes, this includes SSRIs.’
How does Professor Wong reach this conclusion, there are more people on antidepressants than ever before, so nobody is being deterred. So anyone with depression shouldn’t be told the truth in case they don’t take the medication ??
” The risk of suicide is greater” I’d like to see the evidence that proves that. My son didn’t even have depression and was prescribed ssri off label for a totally different condition. There’s no doubt in my mind that during the height of withdrawal if he had not been apprehended he would have killed himself and the police were concerned about the risk of him trying that as well not just me. He has no mental illness and no depression and yet he was psychotic and at a high risk of killing himself within one week of stopping venlafaxine. How is that explained ?? It can’t be explained away as a return of depression or any type of mental illness because he didn’t have one to begin with. He’s never had anything like that episode before or since. So should he just be brushed under the carpet in case he taints the image of SSRI’S.

“In the real world of the clinic, SSRIs are undeniably effective in treating individuals with major depression. They have become the first line treatment of choice because they have fewer troublesome side-effects than their predecessors, and are safer in overdose”

Fewer troublesome side effects !!! For some maybe, what about the others should they just put up and shut up. I would be interested to know if Professor Wong would be able to put up with the horrendous side effects and withdrawal my son suffered on venlafaxine.
Why do none of them get it ??? Yes they have a use, yes they are helpful to some but for some they are downright dangerous and while ever that continues to be ignored and ridiculed they will remain dangerous.

Declared interests:
The research referenced in my comments was not sponsored by the pharmaceutical industry.

And there we have it. Short but sweet.
The research referenced may not be sponsored. Interesting but not really the point and not really a declaration of interests more a little after thought. I’m interested in Professor Wongs interests and ties to the Pharmaceutical Industry.

Professor Wongs husband is Julio Licinio MD. In 2006 he was saying that it’s ok for adolescents to take Prozac and suicide rates had decreased. He accepted his consultancy post with EL after the study of course !
This is the declaration of interest.
Prozac is made by Eli Lilly and Co. The pharmaceutical company was not involved in the design, preparation, review or publication of this paper, and was unaware of the research until after it was accepted for publication. Licinio accepted an offer to consult for Eli Lilly after this research was accepted for publication.
Apparently Eli Lilly knew nothing of him even though he had had given a talk for them before he did the study.

There seems to be an air of desperation in these declarations by the high and mighty in p;sychiatry. After all, if it is truly made clear that “the Emperor has no clothes”, what will naked psychiatrists do for their day jobs?

Are you suggesting that there’s some fabrication going on (“make things up out of whole cloth”)…?
Perhaps, instead of psychiatry, this group of individuals should take up tailoring. Might be more honest, if not more lucrative.

1Mind and Brain Theme, South Australian Health and Medical Research Institute and Department of Psychiatry, School of Medicine, Flinders University, Adelaide, SA 5000, Australia

Correspondence: J Licinio, E-mail: julio.licinio@sahmri.com

It is time for a concerted effort, the ‘War on Mental Illness,’ to be launched.

On 23 December 1971, the then US President Richard Nixon signed the National Cancer Act of 1971, a United States federal law. The act was intended ‘to amend the Public Health Service Act so as to strengthen the National Cancer Institute in order to more effectively carry out the national effort against cancer’.1 This has been widely perceived as the official launch of the War on Cancer. If one looks back at 1971, we were technologically unprepared to launch such a war then. At that time, medical research was severely limited by insufficient technology—there was no magnetic resonance imaging (MRI), no positron emission tomography (PET), very rudimentary molecular biology, no genetically modified animals, no automated DNA or human genome sequencing, no personal computers, no databases, and no universal access to bibliography. Scientific manuscripts were handwritten and then typed with manual typewriters, with no possibility for cutting and pasting. A revised version of a scientific article had to be typed in its entirety from scratch. Obviously, all our current ‘omics’ platforms, such as genomics, proteomics, metabolomics and lipidomics had not even been dreamed of. Yet, the enormity of task, the audacity of the goal, and the technical limitations of the era did not prevent the launch of that ambitious and immensely successful effort. While some cancers, such as pancreatic carcinoma and glioblastoma multiforme, remain uniformly fatal, others have been, for the vast majority of patients, either cured or transformed from a death sentence into chronic illnesses that one manages and lives a long time with.

We propose that it is now the time for a ‘War on Mental Illness’ to be officially and rapidly launched, both as national efforts within various countries and also as an international initiative. The goal of that effort will be improved translation of science into health care, resulting in more efficacious treatments than what we have available today.

Topof pageThe need for the ‘war on mental illness’

Psychiatric disorders represent a substantial burden to the world. Depression is an excellent case example, as it is in average the second cause of disability in developed countries and the fourth in the entire world.2 In Australia, depression represents the largest cause of nonfatal disease burden.3 Moreover, suicide, which is in most cases an outcome of depression, is the third cause of fatal disease burden in Australian men. It is noteworthy that depression precipitates a variety of negative mental and physical outcomes that contribute to poor health both in children and adults. Nearly one-third of people with major depressive disorder also have an alcohol problem, according to the US National Institute on Alcohol Abuse and Alcoholism (NIAAA). In many cases, depression may be the first to occur, thereby leading to alcoholism. Research shows that children with depression are more prone to develop alcohol problems once they reach adolescence. Teenagers who have had an episode of major depression are twice as likely as those who are not depressed to start drinking alcohol. Alcohol abuse in adolescence and adulthood is a cause of physical illness as well as traffic accidents. Furthermore, depression also contributes to obesity. Depressed patients gain weight during the course of the disorder,4and also as a result of antidepressant treatment.5 Having depression makes the treatment of obesity particularly challenging, as the symptoms of depression preclude adherence to diet and exercise guidelines and are a major obstacle to healthy lifestyles. Depression by itself also increases the risk of type 2 diabetes by 60%6 and doubles the risk of cardiovascular disease.7 Recent studies have documented that by shortening telomeres, depression has a negative effect on the ageing process.8, 9 If one adds to the burden of depression those of bipolar disorder, schizophrenia, autism, eating disorders and many other psychiatric disorders, it is easy to see that the cumulative impact of these disorders in the world is truly staggering.

Topof pageThe time is right for the ‘war on mental illness’

One could make the case that psychiatric disorders are harder to study than cancer, which can be put into cell cultures or in animals to be dissected in the lab. While that may be right, it is also true that the infinitely better tools that we have today, compared with what was available for the ‘War on Cancer’ in 1971, give us a stunning advantage that our oncology colleagues of the early 70’s did not have. In a way, the higher complexity and inaccessibility of psychiatric disorders are more than offset in 2014 by the astoundingly superior tools available to us. Therefore, we are at the present time far better positioned and therefore readier to launch a ‘War on Mental Illness’ than our oncology colleagues of 1971 were to start their exceptionally successful ‘War on Cancer.’

It is unquestionable that a ‘War on Mental Illness’ is necessary, timely, and technically feasible. That being the case, how can we get started? In our opinion, this new ‘war’ needs to be fought along all the steps of translation. Therefore, it is worthwhile to define those.

Topof pageThe six steps of translational science

The process of translation in all areas of medicine, including psychiatry, can be conceptualized as occurring along six steps, from T0 to T5, as follows (see Figure 1).

Figure 1.

The six steps of translational medicine: T0, discovery; T1, first in humans or proof of principle; T2, clinical trials; T3, health-care policy and guidelines; T4: long-term effectiveness and safety, and T5, global health.

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T0: Discovery

Because T1 has already been used by many as a level of translation, we call a preceding step T0 (T zero). This refers to the fundamental process of discovery, which is sometimes forgotten in discussions on translational science. Translation cannot be a pipeline only, or a bridge from nowhere. It is not the case that all fundamental discoveries have occurred and that if we bring to the clinic all the advances of recent years, disease will be conquered. Much fundamental discovery work still needs to be done so that proper translation can occur. Hypothetically, one could have the best translation pipeline, but without translatable new fundamental science, such pipeline becomes meaningless. This step is also critical if we are to distinguish translational science from purely applied research.

T1: First in humans or proof of principle

This refers to the now ‘classical’ step of bench to bedside—first in human studies.

T2: Clinical trials

The step of translation from bedside to clinical care: clinical trial studies, for example, are in this domain.

T3: Health-care policy and guidelines

This term has been emerging but needs further definition. We believe that this is best defined as translation of new evidence into health-care guidelines and health policy.

T4: Long-term effectiveness and safety

We define this step as a research on the outcomes assessment of translation. Once translation occurs from T0 to T3, from novel fundamental discovery to health policy, the outcomes of such changes in practice need to be meticulously and critically evaluated, as not all new guidelines and policies will be shown over time to work out. Careful research is needed to determine what is successful in the long run and what is not in order to guide the health care of the future.

T5: Global health

This consists of global implementation of new guidelines that emerge, as the outcome of translation after research at the T4 level further validates effectiveness and utility.

Topof pageThe three gaps in the pathway of translation

We have identified the following three major gaps along those six steps that constitute the pathway of translation, at the levels of knowledge, practice and adherence, which we refer as G1–G3 (seeFigure 2).

Figure 2.

Three major gaps are identified along the pathway of translation, at the levels of knowledge, practice or implementation and adherence.

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G1: Knowledge gap

This is the gap caused by the lack of discovery and the absence of usable data. It is remedied by translation steps T0, T1 and T2. The take home message at the level of this gap is that in the absence of knowledge or evidence, there can be no evidence-based medicine.

G2: Practice gap

On many occasions, existing knowledge is simply not translated into actual, real-life clinical practice. This is also known as translation into practice or implementation. It has been estimated that it takes ~17 years for research evidence to reach clinical practice.10Overcoming this gap is challenging, as it requires a process of ongoing education by practitioners so that new knowledge can be consistently translated into the clinic.

G3: Adherence gap

It is common that both clinicians and patients agree on a therapeutic course of action, which is then not followed. As an example, a large European study showed that 56% of patients prescribed an antidepressant stopped taking them on their own within 4 months.11 The critical issue at this level is the modification of behaviors, which is tremendously challenging.

Topof pageThe necessary elements for the ‘war on mental illness’

Keeping in mind these six steps and three gaps in the translational process, how can we then proceed to successfully launch a ‘War on Mental Health’? Our vision for that is summarized in Figure 3 andTable 1.

Figure 3.

A strategy summary for the ‘War on Mental Illness’.

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Table 1 – Components of the ‘War on Mental Illness’.Full table

Investigator-initiated research

First, we believe that there is a key role for existing investigator-initiated efforts, either as single projects (known as R01 grants in the USA or as project grants in Australia) or as clusters of projects (known as center grants in the United States of America or program grants in Australia). Obviously, for a ‘War on Mental Health’ to be successful, a higher number of investigator-initiated grants needs to be funded. Furthermore, targeted calls for research, with dedicated budgets, need to be established. Those are known in the United States of America as Request for Applications or RFA’s and in Australia as Targeted Calls for Research or TCR’s. They should cover, in separate mechanisms, basic discovery, psychiatric neuroscience translation and translation into practice (implementation). It is essential that funding streams for these three domains be completely separate from one another, each with their dedicated budget, so that one approach does not compete with the others. There has to be a particular emphasis on funding mechanisms for discovery in the domains of mental health and psychiatric neuroscience, as fundamental knowledge related to psychiatry still needs to be drastically advanced.

National and international networks

While investigator-initiated efforts are indispensable, it is highly unlikely that a disease like schizophrenia will be conquered by advances accomplished in one single lab, funded by one single grant. All mental illnesses are common and complex disorders of gene–environment interactions. Those are best approached by well-structured and well-funded consortia, which have existed with great success in other areas of medicine, including cancer, heart disease and endocrine–metabolic diseases. Such consortia should be funded in translational psychiatry both at the national level and internationally. Figure 4 summarizes the elements for a proposed International Translational Psychiatry Consortium. That type of international partnership would be structured to fully cover the six steps of translation. T0—Discovery: to identify and integrate the most promising discovery efforts. T1—First in humans or proof of principle: partnerships among leading clinical psychiatry research centers. T2—Clinical trials: to create a rigorous international academic clinical trial network. T3—Health-care policy and guidelines: Interface with relevant health agencies in various countries. T4—Long-term effectiveness and safety: is what we are doing working well over time? T5—Global health: international partnerships and outreach with innovative international clinical and training programs, such as a Global Masters in Translational Psychiatry.

Figure 4.

The structure for an international translational psychiatry consortium, developed to address the six stages of translation.

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Global mental health

The issue of global mental health is very timely. The miserable, inhumane and appalling conditions faced by the mentally ill in some low- and middle-income countries constitute one of the great human rights scandals of our era.12 Efforts analogous to those of the Bill & Melinda Gates Foundation, that is doing so much to address infectious diseases, must be created for worldwide mental health, as vital for human dignity. Such global mental health efforts should be an important constitutive element of the ‘War on Mental Health.’

Mental health in academic medical centers

In developed countries, the stigma of mental health manifests itself in a more insidious way. Groundbreaking advances in treatment tend to occur in academic medical centers. Because psychiatric services do not offer intensive and invasive procedures that can be billed at top dollar, profit-oriented hospital administrators, who increasingly lack any medical background, have in many cases greatly reduced or simply terminated psychiatric services in academic medical centers.13, 14 A ‘War on Mental Health’ should include a federal requirement for academic medical centers to have inpatient and outpatient psychiatric services in a fixed formula that would be proportional to their size. This way, large academic health sciences centers would have large psychiatric services.

Translational psychiatry centers and institutes

There are very few dedicated translational psychiatry centers and institutes in the world. The number of those needs to be increased, both as independent entities and as national intramural research programs, where new ideas can be tested and developed without the long delays caused by the search for external funding. Such translational centers and institutes should be structured to promote integration along both vertical and horizontal axes, as we recently described (see Figure 5).15 Briefly, vertical integration is what is presented in Figure 1, from T0 to T5. Horizontal integration cuts across disease states along either scientific themes, such as inflammation and neuroendocrinology, or along technical domains, exemplified by imaging and the ‘omics platforms: genomics, proteomics, metabolomics and lipidomics.

Figure 5.

A conceptual framework for psychiatry. Top panel: in the brain-defined structural changes, such as the plaques and tangles of Alzheimer’s disease, or to be discovered or confirmed microstructural or functional changes can lead to key symptoms. Bottom panel: parallel and simultaneous tracks of integration along both thematic and technical horizontal axes and at the vertical translational level are needed in psychiatry (from Licinio and Wong,15 with permission).

Full figure and legend (99K)Download Power Point slide (226 KB)

Philanthropic initiatives for new and untested ideas

In contrast to cancer and heart disease, philanthropy in psychiatry in still in its infancy. We are grateful for the support offered by Connie Lieber and the Brain and Behavior Research Foundation (formerly NARSAD) and the Stanley Medical Research Institute. Nevertheless, many more similar bodies should be created in our field so that there can be adequate support for new initiatives, innovative approaches and untested hypotheses, leading to the collection of pilot data and positioning for competitive application to government funding.

Sole proprietor researchers (biohackers)

In traditional medical research settings, investigators are typically given very little to nothing by the institutions that employ them. Vast numbers of medical researchers are 100% self-funded, bringing in the entirety of their own salaries from external sources. Moreover, the infrastructure they use is all paid for by the direct and indirect budgets of their own grants. Additionally, they have to teach (usually for free), to contribute to committees and to engage in other administrative tasks for which they are not paid and that distract from their core research mission. As a reaction to what they perceive as an exploitative type of structure, some researchers, also known as biohackers, are becoming de facto sole proprietor businesses, engaged in noninstitutional science and technology development. They lease their own bench space and infrastructure and operate like micro-companies.16 There are new funding programs, such as SynBio axlr8r and the Thiel Foundation, that provide early-stage support to high-risk, high-reward independent ventures. SynBio axlr8r is a program that jump starts synthetic biology companies with funding from SOS Ventures, a venture capital firm in Kinsale, Ireland, with a goal of taking an idea through proof of concept to form a company within 90 days. The Thiel Foundation from San Francisco, CA, USA, created by Peter Thiel, cofounder of PayPal, supports fellows to ‘pursue innovative scientific and technical projects, learn entrepreneurship from the ground up, and begin to build the innovative companies of tomorrow’ (Thiel Fellowships http://www.thielfellowship.org). Europe’s budding biohacker scene includes La Paillasse in Paris that is growing rapidly and, with public funding and support from the Mayor of Paris, will soon move to a larger building in the city center.

Commercialization

Eventually, new treatment approaches need to be effectively commercialized in order to reach vast numbers of people and make a difference in their lives. This requires facilitation and support of start-up and incubators and efficient tech transfer, which tend to be a roadblock and source of delayed translation in academic institutions.

Given recent conflict of interest scandals in Psychiatry, it is absolutely essential that the ‘War on Mental Health’ not be tainted by such egregious misconduct. Therefore, guidelines and frameworks for interaction with big pharma companies need to be developed to ensure expediency and feasibility in the context of the highest ethical standards.

Prevention: wellbeing, resilience and early-life intervention

While a war on established mental illness is very much needed, according to Benjamin Franklin ‘an ounce of prevention is worth a pound of cure.’ In that context, efforts to promote wellbeing, such as positive psychology and resilience building,17, 18 as well as the adoption of health lifestyles, including stress reduction, proper nutrition and exercise, ought to be an integral part of the ‘War on Mental Illness.’

It will be likewise crucial to develop and apply preventive strategies for those who are vulnerable to mental illness in childhood and adolescence, before psychiatric disorders become established chronic conditions. This represents a difficult challenge with two factors that need to be delicately counterbalanced. On the one hand, it is logical to propose early intervention before psychiatric disorders become a chronic burden; on the other hand, it is detrimental to prematurely label children and adolescents as mentally ill and to treat, sometimes with undesirable outcomes, young people who may in the long run do well without intervention. Given the potential pitfalls of applying diagnostic labels and exposing any vulnerable group, such as children and adolescents, to treatment and treatment-related adverse events, we believe that it must be absolutely required for early-life preventive and treatment strategies to be supported by the most rigorous science.

Topof pageAdditional considerations

This ‘war’ needs to be launched simultaneously on multiple fronts. There is much that can be done within the existing structures and of course more resources are needed to either create or enhance the constitutive elements of the ‘War on Mental Illness’, which are summarized in Figure 3 and Table 1. As the ‘war’ evolves, other elements will undoubtedly emerge. Over time, the ‘War on Mental Illness’ will certainly become bigger and more powerful than the sum of its parts, leading to truly innovative treatments, improved therapeutic approaches and effective prevention.

It is tempting, but unwise, to disregard current approaches as having at best reached a plateau and focus resources solely on the search for new treatments. Many patients with psychiatric disorders achieve full remission with existing interventions, whereas others have only partial or no response. Importantly, some patients may respond very well to some treatments and not to others. They may also stop responding, without reasons that are clear at this time. Pharmacogenomics is aimed at unraveling the genetic basis of treatment response. When we discover a priori through genomics, or other types of biomarkers, which patients will respond to which drugs, therapeutics in psychiatry will be much further ahead than it is now.19 Consequently, efforts to discover new treatments should be complemented by an equally strong emphasis on personalizing and optimizing existing interventions or drugs.

Much emphasis has been placed in recent years on research that is peer reviewed before it is done, as is the case for existing grant mechanisms. In this context, many intramural research institutes have either been reduced in size or dismantled over time.

The US National Institute of Mental Health (NIMH) Intramural Research Program (IRP) has suffered considerable erosion in the last two decades. When we first joined the IRP in the early 90’s, its budget was 16% of NIMH’s budget. In 1994, Cassell and Marks chaired a blue ribbon panel on the NIH’s Intramural Research Program, of which the NIMH IRP is part, (http://www.sourcebook.od.nih.gov/oversight/NIH-IRP_Redbook.pdf) and specifically recommended that ‘the total IRP budget for institutes, centers and divisions (ICDs) should not exceed the current rate of 11.3 percent of the total NIH budget.’ The NIMH IRP budget is today 11% of that institute’s total budget, as recommended by Cassell and Marks. This represents a relative reduction of 31% in 20 years. Having faced many challenges over the last two decades, it is hoped that with newly appointed leadership the NIMH IRP will again achieve new heights in mental health research.

In Australia, The John Curtin School of Medical Research (JCSMR) at the Australian National University in Canberra used to be entirely block-funded by a direct allocation from the Australian Commonwealth government. This allowed its scientists to rapidly attain world renown, with milestones such as the award of the Nobel Prize in Physiology or Medicine to three individuals who performed their award winning work there, including neuroscientist Sir John Eccles. However, federal block-funding dedicated directly to JCSMR has ceased to exist and that institution’s research projects are now entirely supported by competitive grants. At present, Australia does not have a National Institute of Mental Health or any stable, secure, long-term sources of funding for research in psychiatric neuroscience or mental health. Other international institutions, which used to be 100% supported by direct funding allocations, have also become increasingly grant dependent.

We believe that while there is a key role for research grants, rapid progress at the cutting edge research can benefit from secure, stable and dedicated revenue streams. For example, the Manhattan project was launched by President Franklin D. Roosevelt’s Executive Order 8807, signed on 28 June 1941, and resulted in the first atomic bomb successfully detonated in New Mexico on 16 July 1945 (Trinity test). Such spectacular success would not have been achieved as rapidly if instead of an intramural Manhattan project the US government had relied on the process of investigator-initiated grants that currently exists in medical research. Under the right conditions, a well run, solidly funded and dedicated program can be more far more efficacious, expeditious and cost effective than dispersed efforts.

The ‘War on Mental Illness’ needs be fought on many fronts, with a variety of strategies and mechanisms. For our success, it is vitally important that different approaches do not compete with another. Instead, they should coexist and work cohesively together towards a common target: the generation of new knowledge and its rapid translation to improve mental health.

Topof pageLaunching the ‘war on mental illness’

We have already reached the threshold in which our efforts to launch the ‘War on Mental Illness’ represent medical, scientific, humanitarian and moral imperatives. Hillel () (Babylon, c.110 BCE-Jerusalem, 10 CE) famously stated, ‘if I am not for myself, who will be for me? And if I am only for myself, then what am I? And if not now, when?’ If we do not stand up, not only for ourselves, but also for the hundreds of millions afflicted by mental illness the world over, who will? And if not now, when?

Table of contentsDownload PDFSend to a friendView interactive PDF in ReadCubeRights and permissionsOrder Commercial ReprintsThe need for the ‘war on mental illness’The time is right for the ‘war on mental illness’The six steps of translational scienceThe three gaps in the pathway of translationThe necessary elements for the ‘war on mental illness’Additional considerationsLaunching the ‘war on mental illness’Conflict of interestReferencesFigures and TablesExport citationExport references

I think it speaks volumes that they use the first atomic bomb being successfully detonated as an example and describe it as a spectacular success …. how telling.

I’ve just read another interview with Licinio. When asked about the critics who think that antidepressants are over prescribed he says that larger problem is not enough people being diagnosed.

As far as I can tell his ultimate aim is to develop genetic testing to predict mental illness. Then the drugs can be given in advance to stop the condition becoming chronic.
At least they won’t need that atomic bomb to destroy the human race.

I Guess some People Are Quite Upset. They should Be, Because These Idiots Debunking Dr. Healy Clearly Live in Another World. What The Heck Is “Switching On Anti-Depression”???? A Vaccine For Depression. LOL, LOL These Guys kill me. Although Being Fair, Some Of The Participants Raise Somewhat Good Arguments. I’m Not Sure Why They Have to Attack Dr. Healy He Has only Stated a Fact. They Act Like He Brought Down The Field of Psychiatry. The Comments Made By The Dr.s and Scientists Are Clearly A Way To Keep SSRI’s Flowing into the Hands Of Patients. They Still Have not Made an Argument On the Phenomena Of Dependence. All They Do Is Attack,Attack And More Attackts On anyone Particularly Another Psychiatrist Who Doesn’t Agree With The Low 5H-T Theory. Look At How Many Scientists And Dr.s Put Out A Comment In Defense Of Their Theories, They Took Dr.s Comment The Wrong way, Manipulated It Just to Start A Verbal and Written War on Anyone who Disagrees with Them and Their Theories.

After the splendid articles above, this is a bit of a minor (damp) squib but

In a previous comment, I cited one Dr Cantopher, who seems to be The Guardian’s main source of expertise on psychiatric matters. So I did a bit of digging: In 2013 he wrote an article on the online paper’s Comment is Free: here is the link to the full thing, but if anyone can enlighten me as to what the paragraph I have quoted below actually means – I’d be forever grateful.

“We need to take note of the available research, while also taking a critical view of it. Here is the upshot, accepted by most of us on the ground: antidepressants usually work, but only for real clinical depression, the type involving a chemical disturbance in the brain, with a full range of characteristic physical symptoms. They don’t work for unhappiness, grief or chemically induced depression and if you take them irregularly or for too short a period, the depression comes back.”

Then I find his biog: link below. Note the little gem of info hidden at the bottom.

Dr Tim Cantopher …is now the staff Consultant Psychiatrist at
The Priory Hospital in Woking . He is also a senior tutor and
honorary research fellow at St George’s Hospital Medical School.

Dr Cantopher is an active teacher/lecturer to general public
and professional groups and is an adviser to a number of
local, national and international companies.

OK, I confess to a conflict of interest about Dr T Cantopher – he got up my nose when I read a previous statement in the Guardian about depression being due to depleted serotonin. But, personal feelings apart, the important point for me is that a respected broadsheet, which makes much of its accurate and independent reporting, is using what seems to me be less than independent source. Many people read The Guardian online, worldwide. Add that to health journalists getting information from SCM – seems that we have probably lost the battle. I have absolutely no idea how one begins to counter either the misinformation, or the persecution of David Healy. No idea.

I think the only way is people power. Share risk.org on any social media. Share the BMJ article by DH on social media so that it’s the top article. I know that’s not academic or scientific but I’m just an ordinary person who wants transparency in medicine so that’s the only way I know how to help.
The more support people like DH get, the closer we get to achieving transparency.
We need to shout louder.

Yes, you’re right. But my voice isn’t very loud on twitter. I’m good at digging out info, and writing – and speaking directly about my experiences. Social media has a tendency to do my head in, as they say. However, what runs through all these blogs is a tremendous feeling of wanting to DO something. Everyone has different skills – is there no way of harnessing them ?

Lobbing an idea into the arena – how about a conference? A Rxisk conference, in a real place with real people. Expensive, enormous undertaking, organisationally complex – but maybe someone out there has experience in events management? Who knows. Might rattle some cages, but strength in numbers? Networking, sharing and listening.

Similarly, Dr Ma-Li Wong and her husband believe a War on Mental Illness is as necessary as the ongoing War on Cancer. “Cancer” must be the new talking point to replace poor old “insulin/diabetes,” which was shuffled out a side door the moment “So Long and Thanks for All the Serotonin” hit the web.

In their manifesto about the war they want to wage, they say:

“[…] we are […] readier to launch a ‘War on Mental Illness’ than our oncology colleagues of 1971 were to start their exceptionally successful ‘War on Cancer.’

The War on Cancer is successful?

In job creation for researchers, maybe. (“Funded” or “funding” appear 17 times in the Licinio/Wong manifesto; “treated” or “treatment” appear 13 times, and diagnosis/diagnoses/diagnosed do not appear at all.)

“Dr Cantopher… seems to be The Guardian’s main source of expertise on psychiatric matters.” – this is terribly concerning, his “expertise” is I’m afraid simply nonsense.
His book “Depressive Illness: The Curse of the Strong ” demonstrates even in Chapter 1 “What is depressive illness” non-science presented as facts regarding biological abnormalities “if I were to perform a lumbar puncture on my patients I would be able to demonstrate a deficiency of two chemicals.”
And more. Non-science on psychological paths to, and out of, depression eg positive thinking etc. Very very concerning. The Guardian needs to know their expert is anything but expert.
See amazon to be disturbed by his book http://www.amazon.co.uk/Depressive-Illness-Strong-Overcoming-Problems/dp/1847092357/ref=sr_1_1?s=books&ie=UTF8&qid=1430276677&sr=1-1
And then someone needs to advise the Guardian to STOP using him.

I did see that he diagnosed a Seroxat withdrawal correctly. I assumed he was a pure pharmatrollogist. Far more likely for pt to get slapped with a bipolar tag.

His writing is word-salad, or phrase salad.

In this para he is all over the map.

“We need to take note of the available research, while also taking a critical view of it. Here is the upshot, accepted by most of us on the ground: antidepressants usually work, but only for real clinical depression, the type involving a chemical disturbance in the brain, with a full range of characteristic physical symptoms. They don’t work for unhappiness, grief or chemically induced depression and if you take them irregularly or for too short a period, the depression comes back.” – See more at: https://davidhealy.org/switch-on-anti-depression-today/#comment-118420

What is clinical depression with chemical imbalance? Sounds like a layperson.

That comment about doing a lumbar puncture on his patients and seeing that two chemicals are depleted – was exactly, word for word, what made me see red in The Guardian double page, centre-spread feature on depression last year. Either Dr Cantopher just copied and pasted it from his book into his contribution to the piece – or some benighted 17 year old intern, working for nothing, did, under instruction from whichever editor was putting the thing together. And I am profoundly glad I didn’t give myself a heart attack by looking at his ghastly book. Thanks.

Someone should indeed point it all out to The Guardian – I just wonder who? They are highly unlikely to take any notice of me, a humble patient – does anyone have any journalist contacts at The Grauniad? Who would understand the point.

“We need to take note of the available research, while also taking a critical view of it.
[sedating codswollop]

Here is the upshot, accepted by most of us on the ground: <<I AM A DOCTOR!
antidepressants usually work, but only for real clinical depression, <<MELANCHOLIA? MDD?*
the type involving a chemical disturbance in the brain <<HE MEANS HIS BRAIN
with a full range of characteristic physical symptoms. <<PRESUMABLY FATIGUE, ANOREXIA, ACHES?
[a warp of agenda shot through with a weft of faux certainty]

They don’t work for unhappiness, grief or chemically induced depression<<ETHANOL and if you take them irregularly or for too short a period, the depression comes back.”<<HE MUST MEAN THE CLINICAL DEPRESSION HE SAYS THEY RELIEVE, NOT THE TYPES MENTION IN THIS PARAGRAPH
[a suitcase bearing gifts from disparate lands. Engage bomb squad before opening]

*Here he is probably talking about the Kirsch study, which gets on my dendrites. It is always cited as the great debunker of antidepressant effectiveness, which I hope it is, with the knowledgable addendum, "but they DO WORK in the most severe cases." But see the graphs. On the studies in the green blocks showed 'clinically significant' effects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253608/figure/pmed-0050045-g002/

These are some excerpts from a Dr C article, Sally Doc P, anyine else interested.

IMO, hehas trouble thinking. It is reflected in his writing.

What do you think he is on? Lamictal? Topamax? Effexor chaser maybe.

——–

*Most of these studies focus on antidepressants because their effects are easy to measure <<– What? Since when are AD effects measured?
Outcome measures are not chosen to measure all AD effects, adverse or otherwise. I would love to get my mitts in the raw data some day.*

*The root of the problem is that good research is difficult and limited. Research is good at showing big effects in large groups of people" <<
It is also good at showing small effects in large groups of people. That is why Killer, Thanatos Necromoff* have over a thousand people in a comparo of two drugs and a placebo.

*Heh. [Keller, Thase, Nemeroff]

"Recent research seems to under-report some side-effects and withdrawal effects of antidepressants."**

**this guy is full of surprises

"Prescription numbers are rising mainly because doctors are getting better at identifying depression, though antidepressants are sometimes prescribed when they aren't needed and won't work." <<This is another one of his multi-topic sentences. <<prescription numbers are rising because there is a captive market of dependent patients, and a new cohort is added every year, bless their hearts.

"Except for people suffering from recurrent depression they are only first aid, buying you time to sort out the issues that caused the depression in the first place.<<before it was clinical depression as his pet indication; now it is recurrent." <<before he said they do not work outside of clinical depression. Not he says to use them for a boost!

"never to use them is to miss an opportunity to provide relief from this horrible illness."
<<Never to use them is to avoid akathisia, PSSD, liver disease, high BP, discontinuation syndrome, serotonin syndrome, mania, psychosis, morning terror. And more.

As well as making me laugh with your riff on Cantopher’s inimitable use of the English language – I’m interested in your mention of ‘morning terror’ as an adverse effect. (This is a side issue, sorry) – I’ve never come across anyone else specifically refer to that: I used to wake up with a massive start, bolt outside into the fresh air and sit shaking, with heart thumping. Terror is exactly what it was – but I had no idea what I was terrified of. Eventually my therapist and I called it “The nameless dread”. I assume now it was part of akathisia, but it was just so peculiar, specific and – literally had no name. It certainly wasn’t generalised anxiety disorder.

Yup, I used to wake up with a start and pounding heart around 4:30 a.m. every darned day. Along with the pounding heart I felt dread, terror, regret, loss, hopelessness, and despair. It felt like an icy-hot membrance encased my head.

That was my daily experience for over a year after withdrawing from all drugs.

I had full-on akathisia a few times during my five-year stay in the tenth circle of hell. I don’t remember experiencing dread and terror during the standard pacing/not sitting episodes.

Have a look at “mild akathisia” in the document linked below. It’s in the 6th of the numbered paragraphs.

Sally, I meant to add that this unfalsifiable quip is an instance of DD, or Discontinuation Denialism:
“if you take them irregularly or for too short a period, the depression comes back.”

–Gee, mister, what is too short? Two weeks? Two months?
–If the depression comes back, it was too short.

The part about their not working on unhappiness or grief is more of his pharmagenda. He can’t have his “they only work on clinical depression with chemical imbalance” AND “they can lift your mood the same way stimulants do” so he jettisoned the one that sounds less medical and contributes less to his Godlike feelings of medical mastery.

But he is wrong. Effexor/venlafaxine for one is a speed-like mood lifter. I can’t say what it does for grief, other than cause it. The last time I experienced grief was while mourning the losses I incurred during Effexor withdrawal.

Caroline, a speed-like mood lifter was what I used to say about Prozac’s effects. I called it my “happy pill”….it’s only years later, upon reflection, that I put two and two together and realize that my rages (very unlike me) even professionally – on the job, and my excessive intake of alcohol while taking that drug (for two years, until I got off it) had to do with the drug itself and not anything having to do with me. What a total rip-off.

“David Miller, a professor of sociology from the University of Bath, United Kingdom, presented a more scathing analysis of the SMC, based on a combination of methods, such as analysing the SMC’s website content and sending out freedom of information requests. He looked at which experts the centre uses — given that its mission is to get scientists’ views across.

What he found was that some 20 of the 100 most quoted experts were not scientists, as defined by having a PhD and working at a research institution or a top learned society. Instead they were lobbyists for and CEOs of industry groups”

He is very much an establishment figure. He is president of the Royal College of Psychiatrists in the UK. His wife, Clare Gerada was (is?) Chair of the Council of the Royal Council of General Practitoners.

Simon Wessely is also on the governance board of the American Council on Science and health http://acsh.org/about-acsh/scientific-advisors/ This group is described as an “industry front group” in the book Toxic Sludge is Good for you by Stauber and Rampton.

Wessely played a role in promoting the Chamelford Poisoning Scandal as a case of mass hystertia. This was subsequently refuted by others. Here is a short piece summarising this issue. If you google Chamelford Poisoning Scandal a lot of articles come up about it.

I keep an eye out for interesting snippets on SW as I have ME/CFS and I believe he has done massive harm in this area and held back progress. There is a good chance there is interesting background on some of the other participants in the SMC as well.

The same Professor Taylor who thought C/T off 2mg of Lorazepam was a viable option when I had already expressed how i had been extremely suicidal when i dropped by small increments. His theory was that many in addiction where are on much more than me. Also when i asked him why a psychiatrist would cross me over to Valium without a planned cross-taper, his answer was they don’t know everything.

I have been on so many meds in 20 years all causing me to feel suicidal, and the withdrawals have been horrendous with serious physical long lasting trauma to my body as well. GPs are equally guilty as they put you on this poison and cut the cord when you try to get off it as its causing all your problems. Not one doctor has been able to assist me without being condescending or patronising me about their medical experience.

This for me is a typical of care at the Maudsley. At the Bethlem hospital I was weaned off all drugs cold turkey I don’t know how i am still alive after the brutality of the NHS Mental Health.

The serotonin theory is still alive and well at the adolescent psychiatric unit in Winchester where my child is! Her psychiatrist told me in January, when I asked how her drug worked, that it prevents serotonin reabsorption because she is suffering from too little serotonin. I was so shocked that he genuinely appeared still to believe that theory, that I was speechless!

It’s alive and well too at The Priory private psychiatric hospital chain: I quote from their website:

“What is depression?-
Depression is an illness, not a sign of weakness, nobody is immune to depression and it can happen at any age. In fact, around 10% of men and 25% of women will develop it at some point in their life.
At the Priory…A specialist consultant will oversee your treatment, which will usually include a course of cognitive behavioural therapy (CBT) and may also include medication to restore the chemical imbalance in your brain’s limbic system.”

That’s wonderful – now we know that the deranged chemicals happen in the LIMBIC system….I’ve done a lot of reading, but that’s a first for me.

Just to add to the pile of evidence: deranged brain chemicals theories are very much alive here in Fareham. I was talking to a young neighbour yesterday, who has had a bad bout of depression. She explained to me that her GP (who used to be mine until I sacked him) had told her recently that whilst the daytime citalopram was probably boosting her serotonin, he would prescribe some mirtazapine for the night. That would boost her noradrenaline and dopamine, which were low, and which would help a great deal. This particular GP might be irritating but he’s not entirely thick. So – is he selling her a story – or does he still believe the chemical imbalance theory?? I’m not sure which option I find most disheartening.

I’ve given up feeling sorry for GPs, and excusing them on the basis that they can’t be expected to know everything. As they frequently state (moan), they deal with 95% of people with depression/anxiety etc in primary care – so it is surely incumbent on them to keep up to speed with current knowledge??

It’s most disheartening to read that things are as bad or worse in the UK as they are here in the U.S. I had imagined things were better, having read in Whitaker’s excellent “Anatomy of an Epidemic” that, in England, many GPs gave out prescriptions for exercise as first-line treatment for patients who came in complaining of depression.

Just attended a meeting at the elementary school where I am working. In one meeting with a mother (whose child’s behavior was described as “anxious, out of control, trouble sleeping, etc.”) she told us that the child’s pediatrician (who has put this little fourth grader on an ADHD drug, an SSRI, and a sleeping medication of some sort) blamed all his problems on “well, he’s just at that age”….

I wonder just what “that age” is, as i see the drugging of our children as a crime….?